Introduction to Chron's Disease and Nutrition  

Chron's Disease (CD) is an Inflammatory Bowel Disease (IBD) of the digestive tract. CD patients have symptoms such as abdominal pain, diarrhoea, and weight loss. Nutrition is critical in controlling these symptoms and improving overall gut health. In this article, we will look at the role of nutrition in CD and how it can help with symptom management and gut health.  

What is the difference between Chron’s and Ulcerative Colitis? 

Crohn's disease and ulcerative colitis are two inflammatory diseases that make up what is termed Irritable Bowel Disease (IBD). Both of which cause digestive system inflammation. One of the key differences between the two is that Ulcerative colitis only affects the lining of the colon, whereas Crohn's disease can affect the small and large intestines, as well as anyplace from the mouth to the anus. Both illnesses have comparable symptoms such as diarrhoea, abdominal pain, and rectal bleeding. 

Standard treatment 

The basic goal of CD treatment is to control inflammation and achieve clinical remission. Depending on the severity, pharmacologic therapy may be utilised to relieve symptoms, while biologics may be used to induce and maintain remission in high-risk individuals. Although surgery may be required in some circumstances, medicinal therapy is usually required for CD recurrence.  

Because of increased awareness of the environment's impact on the disease and a better understanding of the function of the microbiome, there has been a growing interest in the role of nutrition in CD treatment in recent years. The effect of nutrition on gut health has been studied scientifically. 

Chron’s and the gut microbiome  

The gut microbiota is critical in the development and progression of Crohn's disease. Crohn's disease patients have a distinct gut microbiome, with less variety and varying proportions of particular bacterial species. This change can cause inflammation, and treatments aimed at restoring a healthy gut flora, such as probiotics and dietary adjustments, have shown promise in alleviating symptoms. However, further research is needed to fully comprehend this association and develop effective tailored treatments. Nonetheless, the gut microbiome is a key component of Crohn's disease, with implications for management and potential therapeutics. 

How food plays a part on the gut microbiome 

The gut microbiome is a complex population of bacteria that affects our health, and our food influences the composition and function of this community. A fiber-rich diet rich in fermented foods and prebiotics can foster a diverse and healthy microbiome, but a diet rich in processed and sugary foods can reduce bacterial variety and cause health concerns. Individual responses to food, on the other hand, can differ, and it's crucial to figure out what works best for each person. Incorporating nutrient-dense and gut-friendly foods into our meals can promote gut microbiota health and general well-being. 

Nutrition for Chron’s 

Foods to try for Chron’s 

Based on suggestions, the following foods may be tolerated for CD patients. It's important to remember that CD symptoms can vary depending on severity, and not all of these foods will work for everyone. 

Fruits that are low fiber: cooked fruits, cantaloupe, bananas and honeydew melon. This is typically recommended in patients who have strictures or have had a recent surgery Lean protein: lean cuts of pork, fish, white meat poultry, soy, eggs, and firm tofu Refined grains: sourdough, potato, oats, gluten-free bread, polenta, white pasta and white rice Fully cooked, seedless, skinless, non-cruciferous vegetables: asparagus tips, cucumbers, potatoes, and squash dairy alternatives to try: milk, yogurt, and cheese made from plants like soy, coconut, almond, flax, or hemp, and low-fat fermented dairy like yogurt or kefir 

Meal Ideas 

We have developed a variety of recipes for people suffering from CD illness. Keep in mind that because to the variable nature of CD, these recipes may not be suitable for everyone. We recommend collaborating with a member of our team for personalised advice. 

Meal Habits 

Here are some pointers to assist you improve your daily nutrition, while keeping in mind that meal planning differs from person to person: 

Eat four to six small meals throughout the day. Drink enough fluids to keep your urine light yellow to clear, such as water, broth, tomato juice, or a rehydration solution, to stay hydrated. To reduce gas intake, drink gently and avoid using a straw. Prepare meals ahead of time and stock up on items that you can stomach (see list below). Use simple cooking methods such as boiling, grilling, steaming, or poaching. Keep a food journal to track what you consume as well as any symptoms you may be experiencing. 

Foods to Avoid with Chron’s 

Insoluble fiber foods that are hard to digest: fruits with skin and seeds, raw green vegetables (especially cruciferous vegetables such as broccoli, cauliflower, or anything with a peel), whole nuts, and whole grains Lactose: sugar found in dairy, such as milk, cream cheese, and soft cheeses Non-absorbable sugars: sorbitol, mannitol, and other sugar alcohols found in sugar-free gum, candy, ice cream, and certain types of fruits and juices such as pear, peach, and prune Sugary foods: pastries, candy, and juices High fat foods: butter, coconut, margarine, and cream, as well as fatty, fried, or greasy food Alcohol and caffeinated drinks: beer, wine, liquor, soda, and coffee Spicy foods: “hot” spices 

Diets for Chron’s 

There have been various diets explored for CD, most of which remove foods known to aggravate symptoms. Here's a list with a quick description of each. Please see our blog article "####" for additional information. 

Enteral Nutrition:  

• A liquid nutritional plan that eliminates solid food and is used to achieve remission during illness relapse. 

The Specific Carbohydrate Diet (SCD)  

• The SCD enables the eating of monosaccharides while prohibiting the consumption of disaccharides and the majority of polysaccharides. Permitted foods include meat, eggs, oil, amylose-rich vegetables, and some dairy products, nuts, and fruits, whereas banned foods are specified. 

The Low FODMAP Diet  

• This diet excludes short-chain carbohydrates, which are poorly absorbed and extensively fermented by gut microorganisms. Certain fruits, onions, garlic, and legumes should be avoided by patients. 

Semi-Vegetarian Diet (SVD):  

• A mostly vegetarian diet that severely restricts but does not exclude meat and fish. Based on vegetables, fruits, grains, eggs, yoghurt, and milk, with no processed or refined foods allowed. 

The low fat/fiber limited exclusion (LOFFLEX) diet  

• LOFFLEX is a well-structured regimen for reintroducing foods that were previously avoided due to their tendency to induce CD. 

Gluten-Free Diet (GFD):  

• This diet excludes gluten, however the link between celiac disease and IBD has never been shown. 

The Benefits of Supplements for Chron’s 

Probiotics 

Probiotics are bacteria that can enter the small intestine and colon alive and provide benefits to the host's gut flora. Probiotics have antibacterial properties, promote intestinal epithelial barrier integrity, and improve the host immune response. 

Probiotics are not suggested for persons with active Crohn's disease since they can be dangerous, and there isn't enough proof that they assist achieve or maintain remission. 

If you have mild to severe ulcerative colitis, a special mixture of beneficial bacteria known as the 'De Simone' formulation or Vivomixx, used in conjunction with your usual medicine, can help you achieve remission during a flare. It's a bit pricy, and the suggested amount may vary depending on your weight, so if you want to try it, chat to your dietician, GP, or gastroenterologist first. Another beneficial strain, Escherichia (E.) coli, can help maintain remission in colitis, but at a lower dose. 

Vivomixx probiotics can also be used to treat and prevent pouchitis in persons who have an ileal pouch. 

Kefir 

Kefir is a milk that contains beneficial bacteria that break down lactose. This makes it suitable for persons who are lactose intolerant. Kefir was researched by scientists, who discovered six different types of beneficial bacteria in it. They gave CD and UC patients Kefir to drink for four weeks. CD patients reported feeling better, with less discomfort and bloating and increased energy. Their blood tests revealed that the Kefir helped to reduce inflammation in their bodies, as well as improve the lining of their intestines. Kefir, because of its beneficial microorganisms, could be an effective treatment for CD sufferers. 

Vitamins and minerals 

Because of inflammation, diarrhoea, or intestinal surgery, people with IBD may not absorb all nutrients from meals correctly, putting them at a slightly increased risk of having certain nutrient deficiencies than the general population. As a result, patients with IBD should have yearly blood testing with their doctor or gastroenterologist to check for essential nutrients such vitamin B12, folate, iron, and vitamin D. While taking vitamin/mineral supplements "just in case" may seem like a good idea, high quantities of some nutrients can interfere with the absorption of others, so talk to your healthcare team about it. 

Omega-3 supplements 

Anti-inflammatory omega-3 fatty acids can be found in fish/shellfish such as salmon, tuna, trout, kahawai, warehou, sardines, mussels, oysters, and squid, as well as walnuts, chia seeds, linseed/flaxseeds, and canola/rapeseed oil (especially cold-pressed). While research on the usefulness of omega-3 supplements (e.g., fish oil) in obtaining or maintaining remission in IBD has produced conflicting results, a high-omega-3 diet has been proven to be beneficial. As a result, while taking an omega-3 supplement is not advised, include high omega-3 foods in your diet on a regular basis is. 

Curcumin 

Curcumin, derived from the spice turmeric, is biologically active and has been shown to alleviate inflammation in persons with active ulcerative colitis. High doses of curcumin supplements, when taken alongside normal treatments, have been demonstrated in studies to assist achieve illness remission. However, because the trials employed diverse curcumin dosages and formulations, there is no currently approved supplement or dose that can effectively treat active ulcerative colitis. 

Nutrigenomics 

Nutrigenomics is a relatively young field of study that investigates how the food we consume influences our genes and overall health. Scientists intend to use this data to develop individualised dietary recommendations for individuals based on their unique genetic make-up in order to avoid disease and promote wellness. While more research is needed, nutrigenomics is showing promise in understanding how food impacts Crohn's disease. See the graphic below for some major findings from the most recent study in this topic. 

Final thoughts 

Many factors contribute to Crohn's disease, including genetics, immune system issues, and gastrointestinal alterations. Food is crucial in the treatment of Crohn's disease, and particular liquid diets can help reduce inflammation and heal the gut. To investigate the link between food and genes, new foods and technologies are being developed. The goal is to provide each patient with tailored dietary therapies to help them control their Crohn's disease. 

We hope that this article can help you on your journey by providing some insight and direction, and that you can walk away with some actionable nutrition takeaways. 

Frequently asked questions about Chron's 

Does milk aggravate IBD symptoms? 

Lactose, a natural sugar found in milk and other animal milks, is difficult for certain people to digest due to a deficiency of the lactase enzyme in the gut. Lactose that has not been digested might cause symptoms such as diarrhoea, cramps, and bloating. Temporary lactose intolerance can occur during active small bowel Crohn's disease, although it usually resolves if the inflammation is controlled. Because liquid dairy products, hard cheese, and butter contain minimal lactose, most lactose-intolerant persons can tolerate tiny amounts of these. Lactose-free dairy products are available, as are lactase enzyme supplements. 

There is no high-quality research to support the claim that minimally processed dairy products cause IBD inflammation. Fermented dairy products such as yoghurt and kefir may potentially improve gut health and symptoms. Dairy is a rich source of protein and calcium, both of which are needed for bone growth, but calcium-fortified substitutes are available for those who do not drink dairy. 

Is it useful to take a break from eating to reduce inflammation in the intestine? 

There is no evidence that eating breaks or periods of hunger can lessen inflammation in the colon. It may, in fact, be hazardous and slow the healing process by inducing malnutrition. Due to inflammation and poor nutrient absorption, the body requires more nutrients and energy during active IBD. Specialized liquid formulae or tube feeds may be required in some circumstances, particularly if there is a bowel obstruction or before/after surgery. For nutritional advice, it is best to speak with a healthcare team. 

Is it helpful to take more or less fibre than usual in the diet? 

A reduced fibre diet may be recommended to control symptoms during active disease in the large bowel or terminal ileum, although a typical healthy diet is normally advised unless certain foods produce unpleasant symptoms. Reduce coarse fibre meals for patients with small intestinal strictures to prevent blockages and cramps, but not too much to avoid restricting the diet needlessly. A high fibre diet, including supplements such as psyllium, oat bran, and germinated barley, may be beneficial to patients with ulcerative colitis in terms of improving symptoms and decreasing disease activity, but increasing fibre intake should be done gradually. 

Can alcohol make CD symptoms worse? 

There is no evidence that moderate alcohol use is harmful to IBD. People with IBD, on the other hand, should be aware of any potential drug-alcohol interactions and check with their doctor or pharmacist. 

Can particular foods aggravate diarrhoea in CD patients? 

While some foods may produce diarrhoea in CD patients, there is no evidence that they cause harm via causing inflammation. It is best to eat smaller portions of recognised problematic foods less frequently, but persons with CD should maintain a regular, nutritious diet in general. The ability of the small intestine to absorb fat may be reduced in some CD patients, resulting in diarrhoea even with a normal fat intake. It's crucial to include some fat in your diet to help with vitamin absorption, and there are medications available to help with fat-related diarrhoea. If you're having trouble managing these symptoms, see your doctor or a dietician. 

How does nutrition affect stomach pain in patients with CD? 

Because abdominal pain in people with CD can be caused by a variety of factors, it is not always evident whether or not food contributes to the pain. If you have gastrointestinal symptoms that cause pain even when your CD is in remission, you may benefit from a dietitian's assessment and guidance to discover if food is a factor. Many persons with CD also have irritable bowel syndrome, which may react to dietary adjustments. 

Abdominal cramps can occur as a result of an intestine narrowing, which causes the intestinal muscle to contract strongly in order to push the contents through the constricted space. Certain meals, such as meat gristle, coarse fibre vegetables, orange pith, dried fruits, mushrooms, or nuts, might aggravate the pain by becoming trapped at the site of narrowing. People with Crohn's disease might consider eating smaller meals more frequently, avoiding these indigestible foods, and carefully chewing all food before swallowing to make a puree to decrease pain. 

Is it possible for specific foods to create excessive flatulence? 

Excessive flatulence is caused mostly by bacterial fermentation of food in the digestive tract. Certain foods, such as those heavy in fat or lactose, might cause flatulence. Other foods can ferment in the gut as well, and people react differently to them. Consultation with a dietitian for a balanced diet may be beneficial if excessive flatulence is an issue.